tempus fugit

Burke and Hare, anatomy, the founders of modern obstetrics as callous murderers, and dissection as class warfare

2015-06-03

The names of William Hunter and William Smellie still inspire respect among today’s doctors, more than 250 years since they made their contributions to healthcare. Such were the duo’s reputations as outstanding physicians that the clienteles of their private practices included the rich and famous of mid-18th-century London.

But were they also serial killers? New research published in the Journal of the Royal Society of Medicine (JRSM) claims that they were. A detailed historical study accuses the doctors of soliciting the killing of dozens of women, many in the latter stages of pregnancy, to dissect their corpses.

Here’s a “cold case” that’s really cold: between 1749 and 1774, with a pause between 1755 and 1764 due to suspicion about how they procured their specimens, the two obstetricians had between 35 and 40 pregnant women killed and their bodies delivered to them for anatomical dissection. The historian Don Shelton built a circumstantial case for murder based on the rarity of natural or accidental deaths of women who were pregnant near to term, that is eight to nine months along.

Don Shelton names Dr Colin Mackenzie and John Hunter, William Hunter’s brother and a celebrated anatomist, as their accomplices. The author of the Guardian article states that William Hunter had links to powerful families that allowed him to avoid any investigation despite the fact that suspicion had fallen on them both by 1755. Hunter apparently resumed ordering the killings in 1764 but limited the “take” to one victim a year and stopped in 1774.

The “resurrection” business– the trade in corpses used for anatomical dissection– was described as “very lucrative” during the 18th and 19th centuries in particular. Two notorious killers, Burke and Hare, gave the name “Burking” to the murder of individuals specifically so that their corpses could be sold to doctors in need of specimens for dissection. They were said to have murdered 17 citizens of Edinburgh in 1827 and 1828. Large cities were poorly policed, and London was described as “unhealthy and semi-anarchic.” The practice of “grave robbing”, or obtaining recently deceased individuals for dissection, was popular and well-compensated, although the bodies normally obtained in this way were usually old or in a state of extremely poor health before death, making them weak subjects if one’s purpose was to look at (“autopsy” means “to look for one’s self”) healthy bodies and organs. Thus, Burke resorted to the much more risky practice of murder for the purpose of obtaining healthy specimens.

Burke and Hare sold their victims to Dr Robert Knox, a popular anatomist of the time who gave lectures in which he dissected corpses and identified their organs for medical students as well as the interested public. They were allegedly assisted by Burke’s mistress and Hare’s wife. They became so notorious that a word for their activities was coined: “burking”, which originally meant to smother a victim, leaving no marks of violence, specifically for the purpose of using the corpse for anatomical dissection. “Burking” was extended from its original meaning of “to suffocate a victim so as to leave no evidence of violent death” to a more general meaning of “to hide wrongdoing or cover-up misdeeds”.

“Burking” was popularized when Burke and Hare were captured and put on trial; their testimony on the stand was discussed and repeatedly endlessly by morbidly fascinated citizens. The degree of interest in such grotesque subjects is difficult for modern people to understand, but until the mid-eighteen hundreds, execution by public hanging was the rule and was attended by huge crowds. Burke was attended by an estimated crowd of 25,000 at his execution and was himself delivered up for dissection afterwards. Hare escaped execution by turning “state’s evidence” and Knox, who kept his mouth shut, was not charged.

Before the Anatomy Act of 1832 (see below), the fear of grave-robbing led to extreme measures to prevent digging up fresh corpses. At some cemeteries, guards were set to watch at night to observe any unauthorized digging; small houses were built for these guards, with fireplaces to keep warm, windows to observe the graveyard, and loop-holes to fire potshots at any trespassing grave violators. At other cemeteries, heavy stones were placed over fresh graves to inhibit digging; when robbers simply dug at the end of the stone to extract the body through the top of the coffin, solid collars were added to keep the body from sliding out. Heavy stone temporary dwellings were also built to store coffins containing fresh corpses until they had decomposed to the point beyond which dissection was unrewarding. After a couple of months, the coffin could be removed and the remains safely buried in the normal fashion.

“Grave torpedoes” were even invented that would explode if someone attempted to dig up the coffin beneath. Naturally, the torpedo was designed to explode upwards to avoid scattering the remains when activated. Through Wikipedia and a Scottish website detailing methods of discouraging grave robbers I viewed the text from a patent for a grave torpedo that dated to the end of the nineteenth century (Google has scanned the text of numerous old patents). Apparently there was still sufficient concern about one’s grave being dug up nefariously at that late date.

In a movie released in 1945, “The Body Snatcher”, Bela Lugosi and Boris Karloff take up where Burke and Hare left off; the movie’s story was loosely based on a short story by Robert Louis Stevenson published in 1884. The movie adds an idealistic young medical student who is forced into the practice of buying corpses by his older, cynical and entrapped doctor mentor. The young student rebels when he discovers a poor young woman he has seen on the street dead in the doctor’s basement, another corpse to be dissected. The perpetrators are killed in a carriage crash at the end of the movie when one of their victims turns out to be still alive and kicking, and has mysteriously turned into one of the killers, supposedly a victim. Of course the killer is trapped in an out of control horse buggy in the pouring rain, with the reanimated corpse crowding him on the carriage seat.

Another film, “The Flesh and the Fiends” (1960), retold the Burke and Hare story with Peter Cushing as Dr Knox, Donald Pleasance as Hare, and George Rose as Burke. This movie, while more faithful to the original Burke history, also includes an idealistic young medical student; this time, the student and his girlfriend are killed by Burke, but the killers are arrested.

The method of the murders, smothering, is said to be the one that leaves the corpse in the best condition and avoids any bloodshed, which could leave tell tale evidence behind.

The problem that doctors and researchers faced for hundreds of years has always been how to see for one’s self how the inside of the human body looks and works. To look at the inside of one’s body usually requires cutting it open; if done before death, it is painful and destructive. If done after death, the body has stopped functioning and much is likely to be missed. Equally important, religious strictures get in the way because it is thought that the body must be retained as intact as possible in order to be raised at the Day of Judgement. Such issues as how the blood circulates could not be settled until it could be seen where the blood comes from, where it goes, and how it returns to its starting point, in a living subject.

The problem of obtaining specimens became acute when Vesalius (1514-1564) popularized the dissection of human bodies to learn anatomy. He discovered that the standard anatomical text of the time, published by Galen of Pergamon (Greece) in the second century CE (Common Era, better known as AD–Anno Domini), had been based on the dissection of Barbary macaques (a sort of baboon) because dissection of humans had been banned. Vesalius began to perform dissections himself and encouraged his students to do the same. He documented his work in his first publication with detailed illustrations that were published as a set of six large woodcut posters in 1538.

Galen had assumed that arteries carried blood to the brain and lungs from the left ventricle, while veins carried blood to the stomach and other, lesser organs from the right ventricle. For this circulation scheme to work, there would have to be a series of holes that interconnected the ventricles; these holes didn’t exist, but until Vesalius began his work, all anatomists agreed that they had found them. Vesalius stated that he couldn’t find these essential holes.

Galen made a number of other notorious errors; for example, he thought that the mandible was two bones, while in fact there is only one mandible bone, joined at the center. He also thought that the sternum had seven separate bones, which is true in apes; Vesalius showed that the human sternum only has three bones. Galen mistakenly thought that the bones of the lower leg were smaller than the bone of the upper arm, also probably as a result of dissecting ape cadavers.

Vesalius corrected some of Galen’s errors, which made him suspect for heresy in the eyes of the Roman Catholic Church, and became famous for his publications. The most important of these works was called “De humanii corporis fabrica”, published in Basel by Johannes Oporinus; it consisted of seven volumes and had 273 highly detailed illustrations, probably created by multiple artists, all of whom must have personally witnessed complete dissections. Vesalius was only 28 when the first edition was published. The book made him famous, and shortly afterward, he was invited to be the Imperial Physician to the Court of Emperor Charles V (of the Holy Roman Empire.)

Envious rival physicians mocked him as a barber (the surgeon was often a barber as well) but he served the court for eleven years and had many opportunities as a result to learn by postmortems, treating battle injuries, and observing the results of medications used at that time. His work was attacked as heretical, but an investigation by the Salamanca Inquisition cleared him of heresy. One of Vesalius’ rivals, his main detractor, claimed that the human body had changed since Galen studied it, and this was why Vesalius’ findings were different.

“In 1564 Vesalius went on a pilgrimage to the Holy Land after being accused of dissecting a living body.” (Wikipedia) On his return voyage, he was shipwrecked and died on the island of Zakynthos; he was buried on Korfu. Apparently the accusation of vivisection, resulting in condemnation by the Inquisition and a forced pilgrimage, was a fabrication. It’s not clear from Wikipedia whether the fabrication occurred before or after his death.

As a consequence of Vesalius’ work, dissection of human cadavers became extremely popular among physicians, and came to be thought of as essential to a doctor’s training. At one point, a medical student was required to dissect three cadavers in the course of sixteen months’s training before he could become a surgeon. Soon there was a serious shortage of material for this purpose, and “Burking” arose to fill this need.

According to Wikipedia, Vesalius freely allowed that he did not have any pregnant cadavers to work with and therefore was unable to fully explain the anatomy of the female reproductive organs. The work of Hunter and Smellie was to correct this gap in medical knowledge, apparently at a cost of nearly forty murdered pregnant women, if this new analysis as reported in the Guardian is to be believed.

The work of William Harvey (1578-1657), who studied mostly animals, contradicted Galen’s explanation of blood circulation. Through many experiments performed on animals from shrimp to pigeons all the way to humans(who were not cut open), Harvey was able to establish that blood circulated from the veins, through the right side of the heart to the lungs and back again to the left side of the heart, and then out to the peripheral circulation through the arteries, finally returning through the veins to the right side of the heart.

Harvey’s work on humans was limited to observations of the results of temporary compression of the upper arm or leg. Lack of blood flow became obvious (and painful) after a few moments of compression to above 200 mm of mercury equivalent. The actions of the veins, and their valves, could be demonstrated with slight compression and “milking” of blood towards the torso; venous valves prevented back-flow of blood when it was stripped through the vein with finger pressure.

Galen’s theory of the circulation had postulated two separate systems, arterial and venous, which came together through invisible pores in the wall of the left ventricle. This theory was contradicted by Arabic scholar Ibn al-Nafis, who saw a circulation of blood from heart to lungs, mixing with air, returning to the heart, and then going out to the rest of the body; his work was not publicized in Europe, however.

Harvey’s book, “De Motu Cordis”, showing how blood actually circulated, caused controversy and accusations of blasphemy. The agreed-upon system, based on Galen, had two separate circulations, as noted above: venous blood, which originated in the liver, and arterial blood, the “vital system”. The arterial blood was thought to contain “spirits” which came from the heart and distributed heat and life to the body. The lungs were supposed to cool the “vital blood.” Pulmonary circulation of the blood was also described by Vesalius, among others, before Harvey completed the circuit.

Harvey’s work was limited by his ability to magnify only with a simple hand lens; he did not have available to him a microscope, although this was developed by Antonie van Leeuwenhoek(1632-1723) shortly after Harvey’s death. Leeuwenhoek, who was primarily a businessman rather than a scientist, kept his method of developing powerful magnifying lenses a secret because he wanted to be remembered for his role in developing microscopy rather than simply lensmaking.

He had discovered a powerful and extremely simple method of creating tiny glass spheres by heating a the center of a long piece of soda lime glass over a flame; pulling the piece apart while it was soft created two thin whiskers of glass. Reheating the end of the whisker made it collapse into a tiny glass sphere which was smooth enough to serve as a powerful magnifying lens. Combining two such spheres would make a microscope. This bypassed the tedious method of grinding a larger piece of glass on a careful pattern and then smoothing the surface with finer and finer abrasives.

Leeuwenhoek’s method of building microscopes didn’t create a demand for cadavers, but it satisfied a demand for close examination of tissues and opened up a new world of “animalcules”– single-celled organisms too small to be observed with the naked eye or a hand lens. At the same time, microscopic examination of animal and plant tissues revealed that they were built up of billions of individual cells that were separated by thin walls. While he is thought of as an amateur due to his orientation towards business, he was able to build microscopes that magnify to at least 275 times (the nine surviving microscopes) and may have reached 500 times magnification(some twenty to thirty were lost over the years).

The resurrection business was slowed down in 1832, at least in the United Kingdom, by the Anatomy Act, which provided for the legal dissection of those cadavers whose relatives did not object to the work. Prior to this Act (which was not universally acclaimed) the supply of bodies for dissection had been drying up, at the same time that the demand was increasing, by the reduction in the number of executions that gradually occurred at the end of the eighteenth century. The Act allowed for persons whose corpses were unclaimed by relatives after death to be “anatomized”, especially those who died in prison or in the workhouses. A person could even donate the body of a next of kin or his own body, in exchange for burial at the expense of the anatomy school.

Dissection was still discouraged by the Church because of a widespread belief that the body had to be intact in order to be resurrected at the End of Days. For the same reason, cremation was thought to prevent one’s rising again to be judged by Christ at the Apocalypse.

In addition, popular revulsion was shown by the actions of “angry mobs”; in particular, Wikipedia mentions the vandalism of an anatomy theater in Cambridge, England late in 1833. People believed that the Anatomy Act failed to prevent the sale of pauper’s bodies for medical research without the individual’s consent. For this reason, the anatomy laboratory was kept under wraps even after the Anatomy Act.

Finally, the passage of the Anatomy Act was hindered by the opposition of the poor for the following reason: the well-to-do would be the primary beneficiaries because, first, they would be free of the fear of their graves being dug up, and second, the advances in medical science would be to their benefit and not to the benefit of the poor, who could not afford medical treatment and doctor’s fees. The poor would be the worse off for the Act because they would be the ones whose bodies would be dissected after they died in the workhouse or without any relatives to claim their bodies. The poor were probably also more likely to believe that they needed to have an intact body to be resurrected and to go to heaven, rather than wander in limbo for eternity.

Thus, even body-snatching can be seen as a class struggle. Not that I endorse that way of thinking: it’s really tortuous and distorted and even silly. In the end, everyone benefits from advances in medical science, and all developed countries other than the United States have universal “free” (insured) health care. No-one is worried about grave-robbing, although there is still a shortage of cadavers for dissection: medical students are assigned, four students to each cadaver, in the first year of medical school.

Nonetheless, poor people distrusted the Anatomy Act and resented the provisions which allowed the government to claim any body that could not be buried at the expense of the family. Thus, if there was no money to pay for interment, “after six weeks” (often in practice, less than one week) the body could be sold for dissection. The body was supposed to be buried after such procedures, with the parts reassembled in a coffin; in practice, often six bodies were combined in one coffin, which was then buried under a numbered crucifix.

Poor people’s resentment of government and distrust of the Anatomy Act’s provisions was, to repeat, based on religious belief: those whose bodies were cut apart in the process of dissection could not rise from their graves intact on the Day of Judgement. To prevent dismemberment, families pooled their resources, purchased insurance policies, or did whatever they could to finance “proper burial.”

This reflects a low opinion of the medical profession in general: the attitude that doctors prefer to work for wealthy people, only do what they get paid to do, and have a habit of covering up unethical practices when they are witness to misdeeds. To stretch a slang term, the poor see doctors as guilty of “burking” their victims.